GOP lawmaker offers a fix for GAMC program

DFL lawmakers aren’t the only ones thinking about a fix for General Assistance Medical Care, the endangered state program that covers impoverished adults without dependent children in Minnesota.

At a packed joint committee hearing Monday in St. Paul, state Rep. Matt Dean, R-Dellwood, suggested tinkering a bit with the Pawlenty administration’s plan to shift GAMC enrollees to MinnesotaCare, a premium-based insurance program for low-income working adults.

While critics have said MinnesotaCare is not suitable for GAMC enrollees for a variety of reasons, Dean said he thinks the focus of legislative efforts should be on "getting the right care at the right time for patients in this population."

Dean wants the Minnesota Department of Human Services to conduct a census of GAMC enrollees over the past two years to get a better sense of who they are, where they seek care and their health-care needs. While 36,000 people are receiving GAMC at any given time, the annual numbers can top 70,000.

"This is a very difficult population," he said, explaining that some enrollees "tend to move in and out of hospital care"and present as "train wrecks" in emergency rooms.

A census also could determine which enrollees would be adequately served by MinnesotaCare, which has a $10,000 cap on inpatient hospitalizations and focuses more on primary care, said Dean, lead-GOP on the House Health Care and Human Services Finance Division.

His plan also would "move away" from the four-month waiting period required by MinnesotaCare before providers are reimbursed for patients’ care, a key sticking point for hospitals and clinics.

Finally, he suggests instituting a county-based "medical care home model," where counties would pick up the MinnesotaCare premiums and determine how best to care for these patients. The medical care home, he said, was suggested by several stakeholders "as not only the cheapest way to deal with this population but it delivers the best care for these folks."

Dean’s proposal comes a few days after DFL House and Senate members presented a plan to restore the GAMC program. Three days before the session ended in May, Gov. Tim Pawlenty used his line-item veto to strike $381 million in second-year funding for GAMC and his unallotment power to cut the program by another $15 million. The House of Representatives was unable to override the veto, with DFL and GOP lawmakers splitting along party lines.

While the next session doesn’t start until Feb. 4, lawmakers are racing to get a solution before March 1 — the date GAMC is projected to run out of money. Last Thursday, DFL lawmakers offered a 16-month plan to restore $292 million in funding for the program by temporarily hiking a surcharge on hospitals and HMOs in order to qualify for more federal matching dollars, seeking a 10 percent share of GAMC costs from counties, setting up county-based accountable care organizations, and eliminating eligibility for certain groups, some of whom might qualify for programs like Medicaid.

At Monday’s hearing, House Assistant Majority Leader Erin Murphy, DFL-St. Paul, emphasized that while the DFL proposal was a "work in progress" she was "glad to have something "concrete" to discuss. Murphy said she and other lawmakers visited nine safety-net hospitals throughout the state and met with numerous stakeholders before arriving at a proposal.

While some critics have objected to a cost shift to counties, Murphy was sympathetic: "The 10 percent county share is a return to former state policy and is not one I’m in love with, and I understand it is a cause of concern."

The 10 percent share is based on how much was spent on GAMC in a given county during the previous year, she said. "For some counties, it’s small ... for others, it’s substantial." Hennepin and Ramsey counties and their safety-net hospitals serve the largest number of GAMC enrollees.

All in all, Republicans and DFLers seemed to be playing nice at the hearing, complimenting one another on the work they’ve put into each party’s proposals and indicating a willingness to work toward a bipartisan solution.

"I’m here to be part of the solution," said Rep. Jim Abeler, R-Anoka, vice chair of the Health Care and Human Services Finance Division. "I wasn’t a fan of the (Pawlenty’s line-item) veto; it wasn’t my advice. ... But what the MinnesotaCare switchover does do is it pushes people to clinics," where care costs less than in hospital emergency rooms, he said.

Comments (5)

Submitted by Burton'Jon Blackwell on December 14, 2009 - 10:46pm.

Reader's and Fans!...
GMAC is no different than any other mismanaged business entity. Let this bungling institution fail...failure is their destiny. Any bail-out plan to revive GMAC at this stage of the game serves no other purpose than to fatten the milker's at the top. Ma and Pa taxpayer's...we have our overall best interest at stake. We all know it's imposible to borrow our way out of bankruptcy unless we have a rich relative that feels sorry for us and feels like throwing their money away. GMAC employee's have talent and will be eventually absorbed by related and competitive members of the industry. GMAC F-A-I-L-E-D! There's nothing there for us to feel sorry for. The sooner this giant paracite dies the sooner we'll recover. Burton'jon

The whole situation is sad, but when there is very little money, there is very little money. Why isn't this situation set-up differently instead of people going to emergency rooms at $1200 a visit. Think about it. The taxpayers paying these costs is ridiculous. Why can't cheaper clinics be set-up for these people to go to and get their needed health care. We certainly can't have them dying on the streets or shelters around the Twin Cities.

Very few states even have programs such as GMAC. Perhaps we need to get people into institutions again if they have mental difficulties instead of closing them up. I see them every day, whereby these souls are dirty, need a shower, carry all their belongings in a Target bag while walking the downtown skyways talking to a person no one can see but them, or they are sitting on the chairs at the IDS building for the day until the shelters open up.

A lot of this GMAC money goes to the local liquar store or to feed themselves out of the convenience store's deli counters. There should have been more rigid rules regarding this GMAC money and what is done with it.

How many of these people come to MN because we are such generous givers? Think about this too. Other states aren't so generous which causes these recipients to come here where the living is good and easy.

I fail to wrap my brain around the argument that somehow, because Minnesota offers something other states don't, we should be less generous. This is a matter a) of public safety, and b) of genuinely moral proportions. I'm willing to entertain a re-tooling of programs that already exist, but removing emergency care funding altogether is completely untenable.

Furthermore, living is not "good and easy" when one has to walk the skyways and sit in the IDS building just to keep out of the cold. Our generosity is, as Mike Opat (Henn Cty Board of Commissioners) said yesterday: the difference between decent health care and "stepping over people's bodies in the street."

The way I see it, the real reason that people don't want to fund this program is the prejudice they feel for its recipients. Just look at commenter #3 above for proof.